Donepezil Could Delay Alzheimer’s Patients Move into Nursing Home

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U.K. researchers, headed by the Institute of Psychiatry, King’s College London, have found that donepezil administered during the later stages of Alzheimer’s might temporarily decrease the likelihood that someone will need to move into a nursing home. The study report, entitled “Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer’s Disease (DOMINO-AD) trial: secondary and post-hoc analyses,” appeared October 26 in the medical journal The Lancet.

Right now Donepezil (called Aricept in the U.S.) is one of the only drugs approved for Alzheimer’s disease. It is used for people with mild to moderate Alzheimer’s, and acts by increasing the levels of the neurotransmitter acetylcholine. A second drug called memantine is recommended for use in people with severe Alzheimer’s.

The study, called DOMINO-AD (Donepezil and Memantine in Moderate to Severe Alzheimer’s Disease), enrolled a total of 295 study participants from England and Scotland, all of whom had moderate to severe Alzheimer’s disease and had been taking the drug donepezil for a minimum of three months. A minimum dose of 10mg donepezil per day for at least the last six weeks was required, and study participants lived at home either alone or with a family member. DOMINO-AD was intended to determine if donepezil could help people with severe Alzheimer’s, either alone or with memantine, over a period of 52 weeks.

The investigators measured modest benefits in memory, thinking, and day-to-day activities in those patients taking donepezil compared to people who did not continue the medication. The research team conducted an additional analysis to determine whether donepezil helped people with Alzheimer’s to stay at home, observing that continued donepezil decreased the likelihood that someone would move into a nursing home within the first year of the study when compared to those who discontinued the medication. The benefit disappeared after the first year, and the addition of memantine had no effect.

According to Dr. Simon Ridley, Director of Research at Alzheimer’s Research UK: “This study is not testing new treatments for Alzheimer’s but looking at the effectiveness of current symptomatic treatments in people in the later stages of the disease. The new analysis builds on an earlier clinical trial that reported modest benefits on cognition and day-to-day activities when treatment with the drug donepezil was continued into the later stages of Alzheimer’s. While the findings suggest that treatment with donepezil in people with advanced Alzheimer’s could help them to stay at home for longer, the authors highlight that the results are exploratory and we know that the factors influencing a move to care are complex.”

Dr. Ridley added: “This study addresses the important issue of improving treatment for those in the moderate to severe stages of Alzheimer’s disease. With only a handful of symptomatic treatments available to treat Alzheimer’s, it is vital that we better understand the most effective ways to use these drugs to help improve quality of life. Increased investment in dementia research is critical, both to improve the use of current symptomatic treatments and to find treatments that can halt the spread of damage through the brain.”